Ischioplasty for Femoroischial Impingement: A Case Report.

Abstract

Hip pain with mechanical snapping is a common symptom with a wide-ranging differential diagnosis, including both extra and intra-articular etiologies. Femoroischial impingement should also be considered since many cases of recalcitrant hip pain may be misdiagnosed cases of this form of impingement. To the best of our knowledge, femoroischial impingement was first described by Johnson in 19771. He hypothesized that superior and medial migration of the lesser trochanter as a result of degenerative changes, posttraumatic changes, or surgery causes a decrease in the distance from the lesser trochanter to the ischium, thus leading to painful impingement. His report included three cases that were limited to older patients: there were two cases with a malpositioned total hip prosthesis and one case with degenerative changes prior to arthroplasty. Subsequent reports have involved only adult patients2-5. Quadratus femoris muscle tears have also been described as an unusual cause of hip pain6-8, and they have been reported in cases of femoroischial impingement3,5. They affect women much more frequently than men3,5, and they may or may not include a history of trauma or surgery9. The pain may radiate to the legs, which may be related to the proximity of the sciatic nerve4,10. Anti-inflammatory medications have been used with variable results as a first-line treatment3-5. Lesser trochanteric resection has been advocated in recalcitrant cases1,2,5. To our knowledge, we present the first documented case of primary femoroischial impingement as a cause of snapping hip syndrome in a fourteen-year-old girl. This diagnosis should be considered in the investigation of snapping hip syndrome as a readily identifiable and treatable cause of hip pain. We offer …